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Impact of Monovalent Rotavirus Vaccine on Rotavirus Hospitalizations among Children Younger Than 5 Years of Age in the Ouest and Artibonite Departments, Haiti, 2013 to 2019

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  • 1 CDC Country Office, Port-au-Prince, Haiti;
  • | 2 Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia;
  • | 3 National Public Health Laboratory, Ministère de la Santé Publique et de la Population/Laboratoire National de Sante Publique, Port-au-Prince, Haiti;
  • | 4 Directorate of Epidemiology, Laboratory and Research, Ministère de la Santé Publique et de la Population/La Direction d’Epidémiologie, de Laboratoires, de Recherche, Port-au-Prince, Haiti;
  • | 5 St. Damien Pediatric Hospital, Port-au-Prince, Haiti;
  • | 6 St. Camille Hospital, Port-au-Prince, Haiti

ABSTRACT.

Rotavirus is responsible for 26% of diarrheal deaths in Latin America and the Caribbean. Haiti introduced the monovalent rotavirus vaccine in April 2014. The objective of this analysis is to describe the impact of the rotavirus vaccine on hospitalizations among Haitian children younger than 5 years old during the first 5 years after introduction. This analysis includes all children with diarrhea who were enrolled as part of a sentinel surveillance system at two hospitals from May 2013 to April 2019. We compare the proportion of rotavirus-positive specimens in each post-vaccine introduction year to the pre-vaccine period. To account for the potential dilution of the proportion of rotavirus-positive specimens from a waning cholera outbreak, we also analyzed annual trends in the absolute number of positive stools, fit a two-component finite-mixture model to the negative specimens, and fit a negative binomial time series model to the pre-vaccine rotavirus-positive specimens to predict the number of rotavirus diarrhea hospital admissions in the absence of rotavirus vaccination. The overall percentage of rotavirus-positive specimens declined by 22% the first year after introduction, increased by 17% the second year, and declined by 33% to 50% the subsequent 3 years. All sensitivity analyses confirmed an overall decline. We observed a clear annual rotavirus seasonality before and after vaccine introduction, with the greatest activity in December through April, and a biennial pattern, with high sharp peaks and flatter longer periods of increased rotavirus activity in alternating years, consistent with suboptimal vaccination coverage. Overall, our study shows evidence that the introduction of the rotavirus vaccine reduced the burden of severe rotavirus diarrhea.

Author Notes

Address correspondence to Eleanor Burnett, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA 30329-4018, E-mail: wwg7@cdc.gov or Gérard Joseph, Laboratoire National de Santé Publique – Haiti, LNSP, Port-au-Prince, Haiti, E-mail: gerardajo944@gmail.com.

Disclaimer: The findings and conclusions of this report are those of the authors and do not necessarily represent the official positions the U.S. Centers for Disease Control and Prevention.

Authors’ addresses: Anne Marie Desormeaux, Manise Pierre, David Fitter, Mark A. Katz, Yoran Grant-Greene, Roopal Patel, and Stanley Juin, CDC Country Office, Port-au-Prince, Haiti, E-mails: pol3@cdc.gov, pierreman@paho.org, vid3@cdc.gov, markakatz@gmail.com, exu4@cdc.gov, roopalpat@gmail.com, and wso7@cdc.gov. Eleanor Burnett, Negar Aliabadi, Eyal Leshem, Jacqueline E. Tate, Michael D. Bowen, Mathew Esona, and Umesh D. Parashar, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, E-mails: wwg7@cdc.gov, naliabadi@gmail.com, leshem@gmail.com, jqt8@cdc.gov, mkb6@cdc.gov, mdi4@cdc.gov, and uap2@cdc.gov. Gérard Joseph, Mentor Ali Ber Lucien, and Jacques Boncy, National Public Health Laboratory, Ministère de la Santé Publique et de la Population/Laboratoire National de Sante Publique, Port-au-Prince, Haiti, E-mails: gerardajo944@gmail.com, lucienmentor@gmail.com, and jboncy2001@yahoo.fr. Patrick Dély and Katilla Pierre, Directorate of Epidemiology, Laboratory and Research, Ministère de la Santé Publique et de la Population/La Direction d’Epidémiologie, de Laboratoires, de Recherche, Port-au-Prince, Haiti, E-mails: pdelky@yahoo.fr and katillapierre@gmail.com. Jacqueline Gautier, St. Damien Pediatric Hospital, Port-au-Prince, Haiti, E-mail: jacqueline.gautier@nph.org. Florence Siné, St. Camille Hospital, Port-au-Prince, Haiti, E-mail: fofiest@hotmail.com.

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